- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $12.77 / $18.27
| Facility | | $7.88 | $12.77 | $18.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $7.96 / $9.66
| Professional | | $7.88 | $7.96 | $9.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $15.89 / $15.89 / $15.89
| Facility | | $15.89 | $15.89 | $15.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $15.89 / $15.89 / $15.89
| Professional | | $15.89 | $15.89 | $15.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.22 / $7.22 / $80.00
| Facility | | $7.22 | $7.22 | $80.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.43 / $7.88 / $8.86
| Facility | | $7.43 | $7.88 | $8.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $7.88 / $7.98
| Professional | | $7.88 | $7.88 | $7.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.00 / $85.00 / $100.00
| Facility | | $75.00 | $85.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,736.00 / $2,736.00 / $2,736.00
| Professional | | $2,736.00 | $2,736.00 | $2,736.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $7.98 / $17.73
| Facility | | $7.88 | $7.98 | $17.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $8.03 / $13.00
| Professional | | $7.88 | $8.03 | $13.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.37 / $8.67 / $17.20
| Professional | | $7.37 | $8.67 | $17.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7.88 / $7.88 / $17.82
| Facility | | $7.88 | $7.88 | $17.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $7.88 / $9.98
| Professional | | $7.88 | $7.88 | $9.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $8.35 / $8.77
| Professional | | $7.88 | $8.35 | $8.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.88 / $7.98 / $11.03
| Professional | | $7.88 | $7.98 | $11.03 |